Provider Demographics
NPI:1891783817
Name:HAGERTY, MATTHEW B (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 S LYNN CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6515
Mailing Address - Country:US
Mailing Address - Phone:816-252-3520
Mailing Address - Fax:816-252-0339
Practice Address - Street 1:3922 S LYNN CT
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6515
Practice Address - Country:US
Practice Address - Phone:816-252-3520
Practice Address - Fax:816-252-0339
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist